I have made my own suggestions with my P. I have a number from 0 to 10.
0 = usually bad normal yuk stuff
up to
10 suicidal.

I have only been a 9 once so far though I have nearly cried 10 twice but told him that I did not want to die, I just wanted the pain to stop and wanted someone to hear how bad it was.

WE have agreed that if I feel 8 or above, I ring Samaritans or text him if it is his working day or I ring a trusted friend or my husband. I find it hard to judge how bad how I feel so it is not easy.

I have also suggested, at my instigation, that if I am doing something harmful to myself I MUST tell him. That is my attempt to be as honest as I an with him which I try to adhere to. Sometimes I only tell him that I am doing something that is not good (don't get me wrong - I do not self harm but sometimes I do things that are not helpful)

He did not ask me to set up any of this. It was my idea and it works for me. there is no sense of 'breaking a contract' as it is only my way of trying to help myself reach out to him when I can. He is very sweet and kind and when I do not manage to do something that I very much want to do, he understands and is sympathetic to my distress.

I guess it would be ligitimate to say that I do not self harm nor am I suicidal so I cannot really comment on a suicide contract. the word contract is the wrong word and I think i used it in another post to anna on a different thread. My suggestions are just that:suggestions that I try to follow.

The contract my last psychiatrist had was, "if you attempt a suicide, I will no longer be your doctor." I don't see him anymore anyway.

With my T....I have no idea....I have been suicidal before, and twice she encouraged me to go to the hospital, but it was never bad enough, (I guess I didn't have a plan or share it with her) where she called 911 or something....I did voluntarily go to the hospital the second time her and I talked about it, though. Was inpatient for 12 days, sigh.

quote:

The contract my last psychiatrist had was, "if you attempt a suicide, I will no longer be your doctor." I don't see him anymore anyway.

My ex-P said this to me too the first day I saw him (he was a total a-hole for the record). He was such a crappy T he's lucky I didn't try to take him up on his offer and was strong enough to leave him on my own accord.

My T mentioned we could make a SU contract thing but we never did my T is kind of a "that's between you and God" sort of girl so she impressed upon me that she wanted me to live, and did do everything in her power to help keep me safe. I brought myself to the hospital once also for a few days and was good with calling crisis when I needed to so I think I've built trust with my T. And actually given my past the best decision for me was not to put me in a box like that and make me agree to anything - it was that sense of freedom over my own life that actually got me through the experience and built mutual trust.

A no harm contract would never work for me I think my T's theoretical views on it are such that.. I need to learn new coping skills and have other interventions in life that help regulate what self harm does (I include my eating disorder in self-harm) sometimes I make bad decisions, but they are mine to make. I think if I was contacting my Ts during or after or something they might have a problem mostly I'm contacting them to PREVENT something bad and they encourage that as a skill. AGain telling me no.. would not be effective but I really think it can be for some people because a no-harm contract is saying "I value you, I don't' want you to hurt yourself" - even if it doesn't come across that way to most people (it might also give someone motivation.. people who really highly value "their word is their honor" it may help pull them through if they promised someone, etc even though ultimately... they can choose to break the promise. It's like making a plan if you have a no-harm contract I would assume with the contract is a list of things you'll do in an emergency instead of hurt/kill yourself. I've always had crisis plans with my Ts just never been told I'm obligated to them and like I said that space for me was actually very important. I think it would have made me feel trapped to have one.

To me it's kind of individual.

So anyway, I don't have one with my T but I do have my own internal version and I think they can be good for some people. anna I'm really glad the contract you have with your T has helped pulled you through

I don’t have a contract with my T, but I do have a “safety plan.” We did it in pencil, on purpose – so that it could be changed. I like it because it lists “red flags” – i.e. thoughts, body feelings, actions I’m doing that could be a sign of where I am at in terms of safety, and it lists things I can do, for each safety “level”. Level 1 is when I’m totally safe, 10 is when I’m not safe at all. It sort of spells out for me signs I need to be watchful of – things that help me know I’m getting more unsafe, before I reach a 10. It also helps me know when I’m at a 10 and what to do. Honestly, I’ve never actually followed it when I’ve been past a 7 or 8, but my T and I talk about it. It’s taken a long time for me to develop – for a long time, I had no idea what anything between 2 and 8 looked like. Now I know what it feels like to be around a 2 or a 6, and noticing unsafe stuff when they are at lower levels it helps me keep from being at higher levels so much. It helps too when I’m in a worse state that I have it written down that yes, it’s ok to call my T when I’m feeling xyz. It’s a good reminder that it is ok, and even a good idea. But my T doesn’t get mad or treat me like I broke an agreement if I don’t call. She might ask why, but she usually already knows I don’t call because it’s too scary or I’m too overwhelmed. She also knows why I avoid the hospital like the plague, and yet that in the end, I will try to do everything I can to keep myself safe, and if I am not safe, and I do SI, it’s because I’m overwhelmed with pain and just didn’t have better skills yet to use.

I read that they did some studies that showed that safety contracts don’t work to prevent self harm, HOWEVER, those studies were done when contracts were imposed by the provider – like the kind of contract proposed by Ninn’s and Cat’s ex-ps. Those feel icky to me. They seem more about making the provider ok.

My old T tried to impose a contract on me, and it was disasterous. She did it because she wanted to help me stop… and it just didn’t help… It was not really “our contract,” it was more like “Ts ultimatums.” I also reacted strongly to the “consequences” she had in it. My current T knows that the “natural” consequences of self harm are enough for me, adding more to it doesn’t motivate me to self harm less.

I think that if a safety contract isn’t mandatory and is working for someone, and especially if the client in therapy suggests and asks for it themselves - if it helps and it works, then hey, that’s great!!! Go for it! I also think that if it doesn’t work, that is very ok too...

I wish T’s and P’s didn’t ever try to impose them on a client though. Someone can start off in therapy not having any SU or SI, but then struggle with it later, and if the T or P has already said, “no SU or SI or I won’t see you,” then the now attached client might be even more distressed and less likely to reach out for help. Yet I do know that some Ts and Ps don’t have the capability to deal with it in a helpful way for a client - If they just can’t deal with clients with suicidal thoughts, I think maybe they should just say right at the beginning that if SU or SI comes up, here’s some people who are better able to help than I can, so then the client knows in advance, and knows that there is hope and help, even if it is not with the T… rather than things like “if you attempt, I won’t see you.” I can't see how that would help anyone other than the provider.

I agree.

Like my T's initial paperwork said, something like, "My office is not set up to take clients in crisis. If you are in crisis, you will be directed to the crisis hotline or nearby crisis center. When the crisis is over, you can resume outpatient services." Which is what she did to me the week after Thanksgiving in 2010. So, I did, on Dec 3rd go to the hospital, and didn't leave till Dec 15th, and didn't see P or T then till January. I wasn't suicidal when I began therapy. This was from Lexapro that I had been on about 5 weeks and was getting worse and worse (which my T agreed, that she noticed it too) and I was going to tell me P, but he cancelled my appt and left for holiday...so because I couldn't call P, I called T, and she told me to go to the hospital.

The next two times I got suicidal were in the spring of 2011 and I was on meds, then, too. The first time I just suffered at home alone, through it, somehow. The next time it was pretty bad I asked my H to sit on my bed till I fell asleep (but he talked and was freaking out and annoying me, so then I told him to go away)....but he did say I couldn't go to the hospital because he needed to work and couldn't be stuck at home taking care of the kids like last time. So, somehow I got through it (but I did end up quitting the meds about 6 weeks later because I felt they were messing me up).

Typing all this out makes me realize why it is so hard to trust the process....

Hi
Thanks for your replays,
Its not legally binding business contract , its more like word of honor that we did write down, with steps what I can do if crisis would happen or I was going to do something bad,
If I feel overwhelmed I can send him mail and so on until The last step is contacting him in his private mobile, I have only once used the last step.

Because like I said in another post I am working sometimes in a hospital in the field where the mental ward is , and my T knows I will not go there , and have my work talking about me ..
The T usually does not take on people in much crisis , he will refer them if they are suicidal to hospital, and he was trying to talk me to got there last time I was in deep crisis, but because I have been with the T for a long time, and I have already been though allot and have hard time trusting someone , he has helped me little bit more, and it did pass .
I am so thankfull I found this place .